Hopkins researchers aim to uncover which mobile health applications work

Global M-Health Initiative

Amy Davis, Baltimore Sun

Dr. Alain B. Labrique (left) and Elizabeth Jordan (front center, in white) of the Johns Hopkins Global M-Health Initiative are pictured with some members of their steering committee, including faculty and students from the Schools of Nursing, Public Health, Medicine and Jhpiego.

Dr. Alain B. Labrique (left) and Elizabeth Jordan (front center, in white) of the Johns Hopkins Global M-Health Initiative are pictured with some members of their steering committee, including faculty and students from the Schools of Nursing, Public Health, Medicine and Jhpiego. (Amy Davis, Baltimore Sun)

Those looking to lose weight, quit smoking or keep tabs on a malady have a lot of choices in the smartphone app stores. Choosing one that's beneficial is more of a problem.

Science is still trying to catch up to the market for mobile health applications, software that runs on mobile devices such as iPhones, Androids and tablets, which has produced tens of thousands of possible ways to achieve better health for free or a fee.

One of the broadest efforts to assess "mHealth" strategies is being made by dozens of faculty, staff and students in multiple departments at the Johns Hopkins University, which has 49 official studies under way in Baltimore and around the world as part of its Global mHealth Initiative.

"It's a nascent field, and few health apps have been rigorously evaluated," said Alain B. Labrique, director of the Hopkins initiative. "A lot of the apps you see out now have a disclaimer, or should have a disclaimer, that they have not been validated through rigorous research. It comes down to the individuals' perceptions that the app works for them."

The center aims to evaluate which strategies can aid doctors, community health workers and consumers in ways equal to other more traditional methods, such clinic visits or in-person coaching.

The findings are likely to shape apps developed and sold in the future, according to those who follow the industry.

There already are more than 40,000 mobile health apps contributing to the $718 million global industry, according to Research2Guidance, an international market research firm. Ralf-Gordon Jahns, co-founder of the firm, said the market size is likely to double this year as the number of smart-phone users and app advertising increases and app sophistication improves.

He expects the number of people downloading a health app at least once this year will reach 247 million, up from 124 million in 2011.

For now, Jahns said, "Most of them are simple apps that do not have a great benefit for the user/patient, but they are creating awareness for mHealth solutions and they encourage people to search for more sophisticated apps. For the health care industry it is a great way to explore the willingness of patients to pay for those solutions out of their pockets."

And it's not just the number of smart phones driving the rise. The number of iPads and other tablets in the hands of consumers doubled over the holiday season, according to Pew Internet & American Life Project.

Using health apps may also be part of a natural progression, said Susannah Fox, associate director of digital strategy at the Pew center. More than 80 percent of Internet users have looked online for health information.

For now, though, only about 10 percent of adult cell phone users have signed up for a health app, a number that Fox said remained flat over the past year. And some of those consumers also likely never used their app, or used it only once, she said.

Pew surveys do show that about half of all adult cell phone users have downloaded an app of some kind, perhaps to track news, weather, sports or stocks. They also found the earliest adopters tend to be young, African American and urban.

"At this stage of the health apps game, we see a lot of potential," she said. "The adoption of tablets and smart phones in the U.S. is moving very quickly. Though, the adoption of health apps is not that widespread."

Research and the market will dictate what comes next. The U.S. Food and Drug Administration has chosen not to regulate much of the industry, just a "a small subset of mobile medical applications that present a potential risk to patients if they do not work as intended."

Those are apps that can be used as medical devices, such as ones that read X-rays or handle electronic health records. A spokeswoman for the FDA says the guidelines should be finished this year.

For now, people like Megan Gubricky, a 25-year-old college student from Catonsville, will decide which apps are bought and used.

She has already tried a couple of health apps to get her into shape, first the Nike training club app and then FitOrbit's Skinnygirl program, a personal training app created by reality show personality Bethenny Frankel.

She said the latter better suited her because it was more personalized. It offered her meal suggestions, a workout plan and feedback from a personal trainer. It also was always available.

"Being able to access my plan at my fingertips was a huge plus for me," she said. "You can check your meal plan and watch the workout demos right on your phone while at the gym so no need to remember. The instant feedback from the trainer is excellent and it is super easy to document your meals without forgetting because it's all right there in the palm of your hand."

Still, research will continue at Hopkins and elsewhere, said Labrique, also an assistant professor in the international health and epidemiology departments.

But he said already there is some evidence that some types of apps have value: They can help patients adhere to their drug regimens through regular reminders; they can help people change harmful behaviors such as smoking with various messages; and they can aid in weight loss through texts about specific goals and behaviors.

"What they all have in common is they increase how often individuals thinks about their health," Labrique said. "Instead of the occasional interaction with a health provider or system, these apps can serve as a 'guardian angel' in your pocket, reminding you often about your goals and ways to reach them. They can keep us on the straight and narrow and the path to good health."

Labrique said some apps and technologies are getting more advanced than specific reminders and encouragement. There are apps and devices that will be able to monitor your health constantly, including physical activity, sleep stress and even food eaten, and give customized feedback. Others may be able to talk to your network of friends and hook you up for ballgame when your schedules allow.

Some apps are in the works that can make a game out of encouraging healthy behavior in children.

Already, he said some pill bottles are engineered to send you a text message or phone your family when you forget your medicine.

Labrique doesn't endorse specific apps, though researchers from the Global mHealth Initiative have created their own software, including a newly released one designed to educate medical students, doctors and other workers around the globe on how to care for burn victims. The app, created by the director of Hopkins Burn Center and the director of academic computing in the School of Medicine, is called BurnMed and shows through pictures, video and text the steps needed to stabilize a burn victim in the first eight hours, the period critical for survival.

Other apps being developed as part of the initiative aim to train health workers caring for those with HIV and AIDS in Uganda and screen and support victims of domestic abuse in East Baltimore.

Still, Labrique said for an app to work, people have to use the technology and follow the advice.

"There is evidence that suggests some apps can have an impact," he said. "But at the end of the day it comes down to individual behavior and a willingness to be coached."

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